- Enrollment id
- O20240516001169
- Enrollment state
- NV
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1508625336
- Multiple npi flag
- N
- Ccn
- 291699
- Associate id
- 8921449307
- Organization name
- ETERNAL HOSPICE
- Incorporation date
- 2023-02-19
- Incorporation state
- NV
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- P
- Address line 1
- 6655 W SAHARA AVE
- Address line 2
- STE B200-108
- City
- LAS VEGAS
- State
- NV
- Zip code
- 891460842